Austria is also a long-standing powerhouse in surgery. Although it is not as good as Britain, France and Germany in general, its upper limit is not worse than these countries.
The College of Surgery in Vienna represents the highest level of imperial surgery. Dean Waterman is recognized as one of the strongest maxillofacial surgeons in Europe. His son Yingenatz is also a famous sharp surgeon, Bill Rotter. The understanding of abdominal surgery is also at the forefront.
As another important branch of surgery at that time, urology, the Imperial College of Surgery also had representatives who could lead the times.
"Teacher Jacob."
As soon as Kawei led a group of people to the entrance of the surgical theater, he met the president of the Urological Association and one of the vice presidents of the College of Surgery who came specially to attend the consultation today: "Today is indeed very special. I have to let people I went to find you, thank you very much."
In terms of seniority, Kawei is enough to honor Jacob, who graduated from the Vienna Medical College in 1846, as a teacher.
However, the tone of respect also appeared in the mouths of Edward, Justina and Edem. Even Mosier, who had never had a good impression of Kawei, still respected him even though he was a few years older than Jacob. .
This relies on Jacob's outstanding surgical ability and his influence.
"You are too polite." Jacob took off his top hat, ushered everyone in, and said as he walked, "I am now semi-out of clinical practice. I only have a name in the surgical college. I am more interested in studying Persia." language and modern medical education reform.”[1]
"What are you talking about?" The first person to speak was Edem, who had never spoken much. "The lithotomy I performed in Paris was improved after several exchanges of letters with you. The surgery allowed me to survive to this day."
"It's over-praised. My little achievement is not surprising."
Jacob has often heard Kavi's name recently, and has seen him a few times in the College of Surgery, but he has never had a good chat. Today is a good opportunity.
He wanted to see what big tricks this young man could do in urological surgery: "I heard that you are going to have a cystoscopy later?"
"Yes, I have improved the previous cystoscope, and I should be able to see the internal structure clearly." Kawei lifted the wooden box in his hand, "But the mirror is metal, and the mirror mouth cannot be turned, so the range of what can be seen is still limited."
"Not bad, not bad, it's a big improvement. I've been doing blind bladder stone removal all my life, and I've always relied on my hands to position it. I didn't expect that the times would develop so fast..." Jacob suddenly stopped speaking, He asked Kawei in a low voice, "This is not the first time that cystoendoscopy has appeared. Are you sure it will succeed?"
"It should be fine."
"Well, Waterman and I are both old, so we still have to look at the young people of your generation next."
Jacob walked into the venue, waving to the colleagues around him who were already seated, and said to Kavi: "If the cystoscopy can be successful, will surgery be performed next?"
"Well, it should be a major surgery."
"Okay, you are young and promising." Jacob smiled and patted his shoulder and said, "I have seen several of your articles in the "Royal Journal of Medicine in Vienna". They are very good. Please forgive me. Less surgical thinking. If hematuria can be diagnosed and cured in this way, I might..."
"kindness?"
Kawei has long been tired of hearing those compliments. Among the words just now, the only thing that aroused his interest was the last half of the sentence: "What did the deputy dean just say?"
"Oh, nothing, nothing..." Jacob quickly walked to the banquet and found his seat, "Go and get ready."
.......
Edem was very surprised that he might be the first person to try the cystoscope. He was so surprised that he wanted to try it out at the embassy yesterday afternoon.
However, out of safety considerations, Kawei's caution, and the time constraints of endoscopic production, he chose to start with corpses first.
Speaking of cadavers, a very strange phenomenon has recently occurred in Vienna's medical industry. The price of corpses, which has been maintained for many years, has suddenly risen a lot since May this year. The original price range of 30-80 kronor has risen directly to 50-120 kroner, and there is no sign of any decline.
In summer, corpses are prone to decay and difficult to preserve, so it is understandable that prices rise. But now it's almost winter, and bodies are still hard to find.
Prices in normal channels have been rising steadily since the middle of the year, and have been monopolized by several institutions. Seventy percent belongs to the Faculty of Surgery and 20% belongs to the Faculty of Medicine of the University of Vienna. And 90% of the remaining 10% was bought by the municipal general hospital, and the remaining hospitals couldn't even get the dregs out of the soup.
If you want a suitable corpse, you either have to dig a grave secretly without conscience, or go to a black market agent to negotiate the price without conscience.
Sometimes those hospitals are so strapped for money that a soaked corpse is not even much cheaper than a French meal. Even so, there are still many hospitals bidding. It seems that the surgery department, which was criticized by the internal medicine department as dirty and unprofessional, suddenly became popular.
For today's experiment, the School of Surgery also put in a lot of effort.
Most of the accumulated corpses are owned. In order to allow the cystoscopy to proceed smoothly, the college spent a high price of 170 crowns yesterday to obtain a "perfect" corpse from an unknown underground market.
"This is the body of a 65-year-old man who died in an accident just three days ago." Kawei looked at the name tag hanging on the toes of the body and said, "It has been preserved with carbolic acid for the past three days. There was little damage to the body, with all limbs and torso intact. The only trauma...
He lifted the white cloth and exposed his shoulders: "The only defect is his head. The head is gone, but fortunately it is not needed for the cystoscopy experiment. It is indeed 'perfect'."
At this time, there were seventy or eighty doctors sitting in the operating theater, most of whom were surgeons who performed lithotripsy, and the rest were physicians who were experienced in kidney diseases. The purpose of their coming here is to give a reasonable diagnosis and get Edem back to health as soon as possible.
Therefore, many people did not come to the meeting with the mentality of watching a performance, but to try to find the loopholes in Kawei's diagnosis. To put it bluntly, it is to find faults based on reasonable logical thinking.
It seems easy, but in fact, when they questioned Kawei, they also entered Kawei's "attack" range.
Therefore, most people will first observe the development of the situation before choosing whether to speak.
Unfortunately, there are always some restless people who do not follow common sense. Before the experiment even started, or even a simple patient introduction began, there was already someone who could not control his excitement and took the lead: "Dr. Kawei, Hematuria is caused by urethral rupture and bleeding. Wouldn't it be inappropriate if you stuffed such a long strip of metal into it at this time?"
Kawei nodded: "You are?"
"Maruna, surgeon at Graz Hospital."
"Grayze Hospital...you should know Dr. Hills, right?"
"It's not even close to knowing each other. I was hired by the hospital a few days before he went to the front line."
This is a substitute who was brought in to fill the vacancy. There is no way to tell how strong he is, but from the content of the question just now, it is not difficult to see that his differential diagnosis ability is still a bit poor.
Since falling out with Edinson, Kawei has received the support of Emperor Franz and Archduke Brecht, and has never thought of saving face for anyone: "This is indeed an issue worth worrying about, but it should not be left in the College of Surgery. was discussed during the consultation."
"Huh? What does this mean?"
"Don't understand?" Kawei looked at him and "translated" the words again, "I mean, this kind of pediatric problem was known to me when I was 8 years old. There is no need to discuss it here. "
These words seem to have been processed. At first glance, they sound a bit exaggerated and even have a touch of magic. But most of the doctors sitting on the stage had seen Kawei's surgical skills on site. Comparing the two, it makes sense for an 8-year-old to know this.
"What do you mean by this?" Maruna was a little anxious. "I just wanted to discuss it with you. I never thought about quarreling."
"I said there is no need to discuss it." Kawei's peripheral vision glanced at Mosier not far away, "Dr. Mosier, you are a surgeon who specializes in prostate surgery. Do you think what I said makes sense? "
Mosier thought for a moment, then slowly said: "I'm not very good at making evaluations...but at least I won't allow my students to ask such questions."
"Thank you for your gentlemanly speech." Kawei bowed slightly to express his gratitude, "Unfortunately, I am not that gentleman."
After listening to Mosier's speech and the gradually gathering attention around him, Maruna realized the seriousness of the problem.
However, the matter has long been out of his control, and Kawei's counterattack will only become more fierce: "If it is just an ordinary urethral injury, it cannot last for such a long time. I feel that as a surgeon who often deals with urethral stones, I will definitely experience The patient suffered from hematuria after surgery. However, as long as the urinary tract is kept open, most surgical injuries can heal slowly within a few days."
This is indeed the basis of surgery and does not require any theoretical knowledge. Anyone who has worked with a surgeon for a period of time will know it.
Maruna's face became even more ugly because he really didn't expect this.
"I have some doubts about the personnel selection system of Graz Hospital. I have to have a good chat with Dr. Hills when he comes back." Kawei went to the preparation area and took out the new cystoscope and said, "Dr. Maruna, this is Yau. I don’t mind you staying here at the consultation site where the patient’s life is at stake, but please don’t make any more noise.”
】
Maruna thought that taking the lead would at least increase his exposure, but unexpectedly the other party didn't take him seriously at all.
Now that my face is gone, I may not even be able to protect my lizi.
"Okay, if you have no other questions, this consultation has officially begun."
Kawei first described in detail Edem's symptoms, his only symptom so far, a long period of asymptomatic hematuria.
"Hematuria does mean there is damage, otherwise the blood would not be able to flow from the blood vessels inside the body to the outside. But this kind of long-term damage must have its special characteristics. If we can't find its special characteristics, we won't be able to make a diagnosis."
Before Kawei undergoes cystoscopy, he still wants to go through the most basic method of diagnosing hematuria: "Faced with a tube of red urine, our ability to observe with the naked eye is limited. At this time, we need to use a microscope."
After that, he took out several drawings left after the examination from the box and sent them to the doctors in the first row: "Here are the cell diagrams that my laboratory researchers saw from the microscope. Everyone, You can pass it around to each other.”
Urine microscopy is a rather unfamiliar term. Many doctors present have only heard of it, but no one has ever done it.
So after getting the manuscript, the somewhat cold atmosphere finally became lively: "Urine sediment is the substance after urine sedimentation?"
"right."
"Can this kind of microscopy be used for diagnosis?"
"Yes, you can take a closer look at the pictures on the drawing."
Fortunately, these doctors still have knowledge of physiology and pathology, and they can at least recognize the cells inside: "This should be red blood cells and some epithelial cells, and that one is white blood cells..."
“What’s the point of checking for cells in urine?”
"Nowadays, after many tumors are removed, it is necessary to use a microscope to see whether the cells inside have abnormal proliferation, and then we can conclude that it is a tumor." Kawei retorted, "Similarly, if there is abnormal proliferation of epithelial cells in the urine, , I also have reason to suspect that there is a tumor in the urinary tract."
"Tumor...tumor...is there! That cell diagram is a bit weird."
"Yes, it is indeed a bit strange. The outline is much rougher than the epithelial cells, and the volume is also much larger."
Kawei watched the drawing spread into the distance, and then said: "Everyone is not very familiar with urine sediment examination, so it is normal not to recognize it. Those 'giant' cells stained blue are tumor cells. I I can tell you clearly that Mr. Edem has a tumor."
Upon hearing this result, the entire surgical theater became restless.
After all, for them, once they suffer from urinary tract tumors, they have to bear the high mortality rate of surgery and the painful daily life after surgery.
However, the microscopic examination just now is only qualitative, and the next step is more important positioning. And only Mosier, Jacob, Massimov and Dean Waterman were on the field who could connect microscopy and cystoscopy in one line.
"First characterize and then locate. The idea is indeed clear enough." Jacob muttered in a low voice, and suddenly asked, "Dr. Kawei, you said just now that the angles that can be seen with today's cystoscopy technology are limited."
"really."
"If no tumor is found, how can you tell whether he has bladder cancer or kidney cancer?"
This is a good question. Kawei had previously thought of explaining it if he saw it during the examination: "Actually, this is easy to explain, because this cystoscopy is not just looking at tumors."
"Not just a tumor?"
"After all, the port of the scope cannot be turned, and the mucosal tissue around the urethral orifice cannot be observed." Kawei compared his hands to a cystoscope and a bladder, and explained, "But the source of hematuria can be seen. After all, the ureteral junction is facing the urethral orifice. It’s the best position for cystoscopy.”
